Table 3.
Intermediate Risk (IR) and High Risk (HR) disease
| IR and HR |
Type of the study/institution |
Year of study |
Number of patients |
Median FU in years |
Treatment | Risk Stratification |
% ADT |
Median ADT duration |
Overall bPFS |
ADT benefit to bPFS |
Overall CSS |
ADT benefit to CSS |
Overall OS | ADT benefit to OS |
Comments and factors predictive of outcome for bPFS, CSS and OS |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LDR | |||||||||||||||
| Lee (81) | Mount Sinai NY | 1990-1998 | 201 | 3.5y | LDR±ADT | IR: 33% HR: 67% |
66% | 6mo | 68% | Benefit to ADT for low D90 | NR | NR | NR | NR | bPFS(ADT, RS, iPSA, D90 in ADT naïve - 25% bPFS benefit to ADT with low D90) |
| Strom (82) | Tampa FL | 2001-2011 | 120 | 5.2y | LDR+EBRT±ADT | IR: 76% HR: 24% |
45% | IR 4 mo HR 28mo | NR | No benefit | NR | No benefit | NR | No benefit | OS (age, trend for ADT benefit in HR (12% p=NS) |
| Merrick (83) | Multiinstitutional US | 1995-2003 | 530 | 5.7y | LDR+EBRT±ADT | IR: 73% HR: 27% |
33% | 4-7mo (3-36mo) | 95.2% | No benefit | 95.2% | No benefit | 77.3% | No benefit | bPFS (iPSA, CS) CSS(CS) OS (age, diabetes, tobacco) |
| Merrick (84) | Multiinstitutional US RCT - 20 vs 44Gy EBRT + PB | 1999-2004 | 247 | 9y | LDR+EBRT±ADT | PSA>10; 15% GS 8-9: 15% |
32% | 4 and 9 mo | 93.2% | No benefit | 97.7% | No benefit | 80% | No benefit | bPFS (PSA, CS) |
| Dattoli (85) | Multiinstitutional US | 1992-1997 | 321 | 10.5y | LDR+EBRT±ADT | IR: 49% HR: 51% |
44% | 4mo (3–6) | 82% | No benefit | NR | NR | NR | NR | bPFS (GS, PAP) |
| Merrick (86) | Multiinstitutional US RCT - 0 vs.20 vs. 44GyEBRT + PB | 1999-2013 | 630 | 7.7y | LDR±EBRT±ADT | fIR: 46% uIR: 46% HR: 8% |
10-56% | 6mo | 99-85% for IR and HR | No benefit | 100-95% for IR and HR | No-benefit | 80-57% for IR and HR | No benefit | bPFS(iPSA, P vol.) CSS (risk groups, PPC, P vol.) OS (age, iPSA, tobacco) |
| HDR/LDR | |||||||||||||||
| Kraus (87) | William Beaumont | 1991-2004 | 1044 pts | 5y | LDR/HDR±EBRT±ADT | IR: 75% HR: 25% |
40% | 6 mo | 72% | No benefit | 98% | No benefit | 83%vs79%for+ADT | No benefit | bPFS (iPSA, GS, CS. ADT improved bPFS 11.5% p=0.02 with LDR/HDR monotherapy. ADT improved FFCF with GS>=8 and bulky local disease |
| HDR | |||||||||||||||
| Schiffmann (88) | Hamburg Germany | 1999-2009 | 392 | 4y | LDR±EBRT±ADT | IR:46% HR:53% |
56% | 3mo | 77%/65% tri vs. bi modality | ADT Benefit (11%-20%) | NR | NR | NR | NR | bPFS (ADT benefit 12% for IR and 20% in HR) |